Pathologists’ experience and routine practice in high-volume lung transplant centers: An international survey

Lung allograft pathology encompasses a wide spectrum of disorders, with new entities and emerging diagnostic technologies. The main goal of this study was to document pathologists' current global practices and highlight areas of consensus and divergence worldwide. A 24-item survey was distributed to transplant centers and responses were received from 35 specialists (51% European, 49% non-European). Most centers used both surveillance and symptom-driven assessments (77%), mainly with transbronchial biopsies (86%) and bronchoalveolar lavage (83%). Non-European centers were more likely to adopt digital pathology (OR 3.03), to use donor-derived cell-free DNA (dd-cfDNA) (OR 2.94), and supported large airway sampling (OR 2.27). Larger centers used dd-cfDNA (OR 2.75) more frequently and consider large airway sampling (OR 2.18). Responders largely supported standardized reporting (86%), reintroducing grade AX (94%), and independent bronchial lesion scoring (82%). Most endorsed an "indeterminate" category for acute and chronic rejection. These findings reflect evolving practices in the field and will inform the ongoing revision of the Lung Allograft Pathology Working Classification.

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Publication Details

Journal
JHLT Open
Published
2025-10-25
DOI
https://doi.org/10.1016/j.jhlto.2025.100415
Primary Topic
Transplantation: Methods and Outcomes
Type
article
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article

Pathologists’ experience and routine practice in high-volume lung transplant centers: An international survey

Prodipto Pal, Jan H. von der Thüsen, Gerald J. Berry, Julien Adam et al.
JHLT Open
Transplantation: Methods and Outcomes
article

Pathologists’ experience and routine practice in high-volume lung transplant centers: An international survey

Prodipto Pal, Jan H. von der Thüsen, Gerald J. Berry, Julien Adam, Izidor Kern, Myriam Remmelink, Benjamin Adam, Gabriel Sica, Francis H.X. Yap, Felicitas Oberndorfer, Lauren D’Sa, Gregory A. Fishbein, Glen Westall, Anja C. Roden, M.R. Qureshi, Birgit Weynand, Fiorella Calabrese, Chieh‐Yu Lin, Kristianna M. Fredenburg, Aurélie Fabre, Kirk D. Jones, Levent M. Akyürek, Deborah J. Levine, Arno Vanstapel, Ángeles Montero-Fernandez, Antonin Fattori, Francesca Lunardi, R. Louis, Alexander N. Wein, Ján Balko, Aliya N. Husain, Elizabeth N. Pavlisko, David Hwang, Teresa Hermida Romero, Nuria Mancheño, Riccardo Iannaco
article en

Abstract

Lung allograft pathology encompasses a wide spectrum of disorders, with new entities and emerging diagnostic technologies. The main goal of this study was to document pathologists' current global practices and highlight areas of consensus and divergence worldwide. A 24-item survey was distributed to transplant centers and responses were received from 35 specialists (51% European, 49% non-European). Most centers used both surveillance and symptom-driven assessments (77%), mainly with transbronchial biopsies (86%) and bronchoalveolar lavage (83%). Non-European centers were more likely to adopt digital pathology (OR 3.03), to use donor-derived cell-free DNA (dd-cfDNA) (OR 2.94), and supported large airway sampling (OR 2.27). Larger centers used dd-cfDNA (OR 2.75) more frequently and consider large airway sampling (OR 2.18). Responders largely supported standardized reporting (86%), reintroducing grade AX (94%), and independent bronchial lesion scoring (82%). Most endorsed an "indeterminate" category for acute and chronic rejection. These findings reflect evolving practices in the field and will inform the ongoing revision of the Lung Allograft Pathology Working Classification.

JHLT OpenVol. 11
Universidade da Coruña (ES), Mayo Clinic (US), University of Padua (IT), University of Liverpool (GB), University of Alberta (CA), University of California, Los Angeles (US), University of Pittsburgh (US), Duke University (US), University of California, San Francisco (US), University of Toronto (CA), Washington University in St. Louis (US), Charles University (CZ), Singapore General Hospital (SG), University of South Florida (US), Royal Papworth Hospital (GB), Sahlgrenska University Hospital (SE), Erasmus MC (NL), The Alfred Hospital (AU), Erasmus Hospital (BE), Royal Liverpool University Hospital (GB), Hospital Universitari i Politècnic La Fe (ES), University of Florida (US), University of Chicago (US), Hospital de São José (PT), University Hospital in Motol (CZ), University Clinic of Pulmonary and Allergic Diseases Golnik (SI), St. Vincent's University Hospital (IE), Mayo Clinic in Arizona (US), Duke Medical Center (US), Hôpital Paris Saint-Joseph (FR), Mayo Clinic in Florida (US), Liverpool Womens NHS Foundation Trust (GB), Université de Strasbourg (FR), Medical University of Vienna (AT), University of San Francisco (US), Stanford University (US)
Openalex Percentile: Top 52%
Transplantation: Methods and Outcomes
DOIOpen Access PDFOpenAlex
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